Your Cat Has an Abscess (and Other Telephone Diagnosis)

Top Ten Diagnosis Your Veterinarian Can (Probably) Make Over the Phone With More Accuracy than a Weather Forecast

Medicine is a hands-on art. The practice of medicine in the United States legally means diagnosing, prescribing, and performing surgery upon animals. Familiarity with an animal or herd means having physically seen or been in contact with the owner and the animal or the housing facilities (in the cases of herds) within an Earth year (365 days). Sometimes, as a veterinarian, Doc Truli wonders how accurate a diagnosis could be over the phone.

For example, all veterinarians know that when a client calls and says a dog is constipated, it probably is not. Probably the dog has such bad diarrhea, that there is no more solid material coming out and the poor dog is straining relentlessly. Treatments such as laxatives for constipation will clearly make the dog miserable.

Veterinarians also know that when a client calls and says there is profuse bleeding and they think it’s coming from a cut on the lip, it’s coming from a cut on the tongue. Lips don’t bleed all that much. Tongues bleed terribly from even the smallest little tear (That reminds me of a story I have for you – but I’ll save it for another week!) So your veterinarian looks like a genius targeting the tongue and finding the problem right away. It’s easy to find something when you already know it must be there!

Other diagnosis are nearly certain, more accurate than a weather forecast, but not 100% until the hands-on physical exam confirms the situation.

Top Ten Telephone Diagnosis (in no particular order)

Cat Fight Abscess

Hole from burst cat bite abscess

If a client calls with a cat who goes outside, especially a house cat that only goes out at dawn and dusk, and the cat does not want to eat, is not moving much, and is lying around, he or she probably has an abscess somewhere. If the cat comes to the office and has a fever, then it is nearly certain.

Cranial Cruciate Knee Injury

This abnormal sitting position indicates a knee injury.

If a dog is suddenly limping and holding one hind leg up in the air when walking and sitting with the leg out to the side, a knee injury is 85% likely. If it is a medium to large breed dog, it is even more likely.

Another scenario could result in a diagnosis of a patellar injury in a small or toy breed dog or cat.

(85% is better than the weather report, right?)

Bloat

If a veterinary receptionist hears the words, “vomiting and nothing is coming up,” “pacing, can’t sit down and get comfortable,” and “belly looks big,” she or he will know that is an emergency!

Blindness

“Doc, when we take Chateau out on the Appalachian Trail, she seems fine until we whistle for her. When she comes running back, she plows into our knees.” Yep, dog is blind. Now, the physical exam did show retinal detachment caused by lyme borreliosis (Lyme disease). That part of the diagnosis could not be made over the telephone!

Redirected Aggression

“I came home and my cat went berserk and attacked me as soon as I came in the door. I had to get 17 stitches in my legs. Plus, there was something really strange, his eyes were pitch black and he did not calm down for 12 hours!” This cat smelled another cat’s urine on the barbecue grill cover by the front door and freaked out and attacked the next thing that moved because he could not get at the cat that he smelled.

Pyometra

See how rounded and tight- bulging this horn of the uterus is?

“My dog is vomiting and isn’t eating much.” Or “My dog is urinating like crazy.” Or “My dog is constipated and panting.” AND “My dog is not spayed and was in heat in the past 2 months.” This dog is likely to have pyometra – a life-threatening uterine infection.

Bufo Toad Toxicity

“My dog (usually terrier) was out in the yard for only a minute and now he’s drooling like crazy and twitching (or seizing.) And you live in a US State or country with Bufo – or cane – toads. Brought to Florida to control pests on the sugar cane crop, Bufos now blanket the state. With no natural predators, they proliferate. One lick can kill a dog. Wash your dog’s mouth out with tons of water (use a garden hose for a large dog). Then get to a pet hospital.

Other possibilities include tumors, fungal infections, injuries, hematomas from bleeding disorders, and cysts. They are probably 5% of the lumps.

Fleas

The bald butt of a flea allergic dog

Crazy right? Everyone knows about fleas right? Well, for one, some people have never seen a flea. For two, some people need their glasses to see a flea and they can’t get them on in time to see the little things. Plus, you cannot see what you do not believe. Half of all skin problems are due to fleas in cats and dogs and ferrets in the United States.

Bonus: Top Two Diagnosis in Pets (and They Are Impossible to Diagnose Over the Phone)

Can you guess the top three medical diagnosis in pets? To be fair- one of them is a broad category of problems that are the most likely reason pets leave their homes and end up at the animal shelter. The other two are common, even in young pets. Probably 90% of my patients over the age of two years have one or the other of these diagnosis. Neither of them can be confirmed for sure over the phone.

I take my cat to the best vet in town and am starting to wonder if I should start driving about 50 miles away to something better…so here’s what I’m asking.

I was wondering if you’ve ever encountered a cat with FHV (Feline Herpes Virus). There aren’t any posts about it and I am sure my cat has it. My vet gave my male cat a two week antibiotic shot for it and it worked wonders for those two weeks. The sneezing came back and slowly tapered off for a while and every now and then he starts getting a runny nose with some sneezing. He is now experiencing, what I’m assuming, abdominal spasms that sometime cause him to defecate. I don’t remember the last time he had a solid BM. As far as I know he has always had diarrhea (chronic at this point). He has a great appetite and great personality and is a very happy cat. Something else that started over the past year is that he gets abscesses on his neck (in the same spot every time) about a finger width below his left angular process. The first time this occurred he had a lot of swelling in the area anterior to his left ear, possibly across the buccal region, and on his chin along with the area around the abscess. He was very lethargic and hid (which was extremely odd behavior). This only happened the first time but since then he has had 6 abscesses with some being back to back. There was about a four month period where he didn’t have one. I had been treating him at home for all of them without incident but figured after the last one I had better take him in. However, my regular vet was out of the office and he had a replacement to fill in and I was not a big fan. She informed me that if she were the one caring for him she would perform exploratory surgery and would most likely cut out that entire section of his neck. She was very rough with him in comparison and he even hissed and tried to bite me. (He has only ever hissed once and has never put his teeth on me.) He is currently healing from his last episode. I’ll be getting a call soon from the vet to schedule an appointment, for what I hope is just another consult with the regular vet to get his thoughts. I was just curious what your thoughts were.

His ears are also dirty with brown wax that has shiny hard bits…that’s the best I can explain it. I do have another cat who is older and she has never had any problems other than the occasional hairball….and her ears are clean.

Hmmm…consider bartonella infection, feline chlamydia (resp and gi symptoms possible). Every cat vet sees feline herpes almost every day. It is a virus, so antibiotics either looked like they worked because it was waxing and waning anyway, or the problem is all or partly bacterial.

See your vet whom you trust.

Btw-I know exactly what you mean about that ear stuff. The “shiny bits,” too. You’ll most likely need an ear cytology microscopic exam of the ear debris in order to diagnose what it is. But great description. I’m going to think of it that way from now on.

I’m confidently going with “behavior problems” as the top reason for ending up in the shelter.

Less confident in these other two guesses. For over the age of two years, I’m going with some sort of dental thing, like tartar or gum disease. And, in my area, I’d say tick-borne disease is one of the biggest diagnoses but I don’t know if that’s true in Florida.

Wow… dental problems? I’ve always had dogs growing up. We’d give him teeth-healthy snacks/bones or brush his teeth periodically. Now I have a cat… should I be brushing her teeth, then? I never actually thouht about it. >_<

Surprise!
Your cat probably has periodontal disease right now! (No- I’m not psychic or stalking your house, I just know 3/4 of cats over the age of 2 have significant periodontal disease.) The cats usually need a deep professional dental cleaning under anesthesia before you should introduce the toothbrush, or else the gums will become as irritated as your cat will be!

If you cannot get to the vet’s right away, there are special diets, like Hill’s Healthy Advantage food designed to scrub the teeth. The Veterinary Oral Health Council tests products to determine if they help or not. You can check out their website for more ideas for how to help your cat’s teeth.

And by the way, I stumbled upon your blog looking for the answer to why my cat has such spastic head movements when she’s curious or interested in something. While I didn’t find the answer, I’d like to say that this is a great blog you have here. I’ve spent the last hour just reading through it. Thanks.